Galantamine (trade names Razadyne, Razadyne ER, Reminyl, Nivalin) is a drug developed by Janssen Pharmaceutica, and used for the treatment of mild to moderate Alzheimer’s disease. It is an alkaloid that is obtained synthetically and from the bulbs and flowers of the Caucasian snowdrop (Voronov’snowdrop), Lycoris radiata (Red Spider Lily), Galanthus woronowii (Amaryllidaceae) and related species. The active ingredient was discovered accidentally by a Bulgarian pharmacologist in the 1950s.[1]

Pharmacology

Galantamine in its pure form is a white powder. Galantamine is a competitive and reversiblecholinesterase inhibitor. It is believed it works by enhancing cholinergic function by increasing the concentration of acetylcholine in the brain. The atomics resolution 3D structure of the complex of galantamine and its target, acetylcholinesterase, was recentely determined by X-ray crystallography.[2] There is no evidence that galantamine alters the course of the underlying dementing process.[3] Galantamine has also shown activity in modulating the nicotinic cholinergic receptors to increase acetylcholine release.[4]

Pharmacokinetics

Absorption of galantamine is rapid and complete and shows linear pharmacokinetics. It is well absorbed with absolute oral bioavailability between 80 and 100%. It has a half-life of 7 hours. Peak effect of inhibiting acetylcholinesterase was achieved about one hour after a single oral dose of 8 mg in healthy volunteers.

Metabolism

The major route of metabolism for galantamine is through the liver, this accounts for approximately 75% of the total metabolism of galantamine. Hepatic cytochrome P450 (CYP) isoenzymes are the active enzymes for this metabolic route. In vitro studies have shown that CYP2D6 and CYP3A4 are involved in galantamine metabolism.

For Razadyne ER (the once-a-day formulation), CYP2D6 poor metabolizers had drug exposures that were approximately 50% higher than for extensive metabolizers. About 7% of the population has this genetic mutation, however because the drug is individually titrated to tolerability, no specific dosage adjustment is necessary for this population.

Clinical use

Indications

Galantamine is indicated for mild to moderate dementia of the Alzheimer’s type.

The U.S. Food and Drug Administration (FDA) sent out a warning indicating that the product should not be used in patients of mild cognitive impairment (MCI) because of increased mortality observed in trials for MCI with galantamine.[5]

Available forms

The product is supplied in twice-a-day tablets, once-a-day extended release capsules, and in oral solution. The tablets come in 4mg, 8mg and 12mg forms. The capsules come in 8mg, 16mg, and 24mg forms.

Adverse events

In clinical trials, galantamine’s side effect profile was very similar to that of other cholinesterase inhibitors, with gastrointestinal symptoms being the most notable and most commonly observed. In practice, some other cholinesterase inhibitors might be better tolerated; however, a careful and gradual titration over more than three months may lead to equivalent long-term tolerability.[6]

Other use

Supplement for lucid dream and out-of-body experience

Some people who practice lucid dream (LD) or out-of-body experience (OBE) use Galantamine to increase their odds to achieve LD or OBE. [7][8][9]
By taking small amount of Galantamine (around 4 to 8 mg) after 5 to 6 hours of deep sleep and practice the induction technique such as meditation, MILD or WILD [2] many people report more success with Galantamine. [10]

There are also reports that taking Galantamine without proper induction technique will not lead to LD or OBE but will result in only a vivid dream instead.

Galantamine used with Choline bitartrate or Alpha-GPC is said to increase your odds of becoming Lucid.

Some people report mixing Galantamine with other nootropic can enhance the degree of lucidity, but this is still controversial since some mixtures may work for some people, but lead to failure for others.

Nootropic

Along with other cholinergics or acetylcholinesterase inhibitors such as Huperzine A, Galantamine also has been used as nootropic or "brain enhancer".

Total synthesis

Main article: Galanthamine total synthesis

Galantamine is produced from natural resources and a patented total synthesis process. Many other synthetic methods exist but have not been implemented on an industrial scale.